The TOPS CMS-1500 Health Insurance Claim Form is the standard paper claim form used to bill Medicare Fee-For-Service (FFS) Contractors when a paper claim is allowed. It is approved by the National Uniform Claim Committee (NUCC) and the Office of Management and Budget (OMB). Designed for use with a laser printer, the form is printed in red optical character recognition (OCR) ink on 20-lb., white bond paper. It is 8-1/2'' x 11'' and comes 250 forms per pack. This version (02/12) went into use

Protect patient privacy and improve record keeping for daily office visits. After patients sign in, simply remove the numbered label strip and file it away into the patient's chart. The carbon sheet transfers names to the back sheet so other patients do not see the previous patient's information.Over 5.5k patient visits accounted for. Each entry is a private label that is used for client folders. Each sheet contains a second confidential copy of the entry. HIPAA approved. 8-1/2'' W x 11'' H.

Small gummed-seal inside tint Medical Claim Form envelope with inside tint. Size is 9-1/2'' x 4-1/8''. Window size is 4 1/2'' x 1-1/8''. Window location is 4'' from left and 1-5/8'' from bottom.BUY MULTIPLE ITEMS AND SAVE ON SHIPPING!----ORDER BEFORE 2:00 PM est (M-F) SHIPS SAME DAY!. ICD-10 Window envelopes specifically designed for HCFA/CMS forms. Small gummed-seal inside tint Medical Claim Form envelope with inside tint.. Window location is 4'' from left and 1-5/8'' from bottom.. Size is

Carbonless bond paper for jam-free performance and are printed in OCR-scannable red ink. All forms are government approved CMS-1500 to serve federal programs and private insurers as a universal claim form.1 Part Laser (5000 Single Sheets - for Laser/Inkjet Printers). 08/05 Version - Factory Sealed. Accommodates reporting of the National Provider Identifier (NPI) number. Meets all Government Standards. No shipping to Alaska, PR, Hawaii, Guam or PO Boxes..

Item Number 1500NC This form accommodates the reporting of the National Provider Identifier (NPI). Printed in red ink on special bond paper in strict compliance with NUCC and CMS regulations and specifications. These claim forms (formerly HCFA-1500) are used to submit health insurance claims for services provided by health care professionals to Medicare and Medicaid, insurance companies or clearinghouses for processing. Printed in red ink on special bond paper in strict compliance with

The Centers for Medicare and Medicaid Services (CMS) healthcare forms are required for all federal insurance claims and many private healthcare organizations. These preprinted and cut size forms speed up claims processing. New Version 02/12: Medicare will begin accepting this Version 02/12 on 1/06/14. Starting 04/04/14 Medicare will accept this Version 02/12 only.1-Part Laser Form CMS-1500 printed in red ink. New Version 02/12 (APPROVED OMB-0938-1197). Medicare began accepting this Version

Item Number 4065S (Replacement Item Number 4065) Capture personal data, insurance information, medical history and more with a colorful, patient-friendly form Size: 8 1/2 x 11 Durable forms 2-sided format 28 pound ledger stock Lined sheet accommodates up to 50 patient names and arrival times Available in English or Spanish 100 two-sided registration and history forms per pad2 sided format. 28lb ledger stock. Available in English or Spanish. 100 Sheets Per Pad. 3 Pads Per Order.

Satisfy recordkeeping requirements with cms-1500 Health insurance claim forms. Per Federal regulations, all healthcare providers must use the cms-1500 form for specific types of billing. The cms-1500 accommodates reporting of the National provider identifier, which must be used by all HIPAA-Covered entities. Laser-cut sheet 2,500 per case printed with OCR ''Dropout'' Red ink on 201# paper, as per government regulationsRequired for healthcare providers to bill a patient's insurance company for

Carbonless bond paper are printed in OCR-scannable red ink. All forms are government approved CMS-1500 to serve federal programs and private insurers as a universal claim form.2 Part Hand Written (10 Single Sheets) Sample Pack. For Hand Written Claims Only. 02/12 Version. 2 part carbonless (NCR) paper. Provides users with duplicate copy.. Accommodates reporting of the National Provider Identifier (NPI) number. Meets all Government Standards.

Record detailed patient history and treatment information. Each chart includes 2 pre-punched holes for easy filing.Records exam on a diagram with additional space to document plans, and completion dates. Unique color coded design makes it easy to find the right document. Printed both sides in green. 8-1/2'' W x 11'' H.

The Centers for Medicare and Medicaid Services (CMS) healthcare forms are required for all federal insurance claims and many private healthcare organizations. These preprinted and cut size forms speed up claims processing. New Version 02/12: Medicare will begin accepting this Version 02/12 on 1/06/14. Starting 04/04/14 Medicare will accept this Version 02/12 only.1-Part Laser Form CMS-1500 printed in red ink. New Version 02/12 (APPROVED OMB-0938-1197). Medicare began accepting this Version

Confidentially sign in your patients! Each patient completes the next available line and removes the number to the left of the name. Patients can then wait to be called by either their name or their number. (Lot of 250).HIPPA Compliant (HIPPA Privacy Rule, Section 164.502). Second Sheet is a complete record of all patients seen that day. Option to call patients by name or number. Carbonless. Pt 1 - Pressure Sensitive EDP Perm Label with 23 face slits, Pt 2 - 17# Self Contained Paper.

The Version 02/12 500 Sheets APPROVED HCFA CMS 1500 healthcare forms (02/12) are designed for all federal health insurance claims and private healthcare organizations. The CMS healthcare forms are required to speed up Bills claims processing to a Patient's Insurance Company for Reimbursements Of Medical Claims. Park Forms offers 500 Sheets of the most up to date CMS claim forms required to receive reimbursements for clients. APPROVED OMB-0938-1197HCFA CMS 1500 healthcare forms Our New Version